Current and research therapies for the prevention and treatment of delayed neurological syndrome associated with carbon monoxide poisoning: A narrative review

Moral-Barbudo, B Del; Blancas, Rafael; Ballesteros-Ortega, D.; Quintana-Díaz, Manuel; Martínez-González, Óscar

doi:10.1177/0960327120901572

Cited by 7 publications

(2 citation statements)

References 28 publications

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“…Hyperbaric oxygen (HBO) therapy is thought to be essential for preventing neurological sequelae in patients with CO poisoning [28]. However, the results have been con icting and the effects of HBO therapy for patients with CO poisoning remains contentious [29,30]. A recent study suggests that HBO treatment with inconsistent protocols showed no advantages over NBO treatment in the prevention of DNS or the improvement in LNS after CO poisoning, and multiple HBO sessions on the rst day of hospitalization were associated with a greter incidence of DNS [31].…”

Section: Discussionmentioning

confidence: 99%

Risk factors and Outcome Analysis of Delayed Neurological Sequelae in elderly patients with carbon monoxide poisoning

Xue

et al. 2023

Preprint

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Objective Carbon monoxide (CO) poisoning is one of the common causes of poisoning in patients and can result in significant neurological sequelae. However, few studies have focused on the elderly population. Method We retrospectively reviewed elderly (age≥60 years) with CO poisoning from non-fire accidents and non-suicid at at the 6th medical center PLA general hospital in China from 2013 to 2023. We analyzed the patients’ epidemiological characteristics and outcome; identified the risk factors for patients who developed delayed neurological sequelae (DNS) and long-term neurological sequelae (LNS); compared the data of patients who received hyperbaric oxygen (HBO) to those who received normobaric oxygen (NBO) therapy. Result A total of 167 elderly patients were enrolled. The annual case number decreased from 2013 to 2023, particularly during the cold months (November to February). The most common source of exposure was coal heating (89.8%). The most common presenting symptoms were consciousness changes (86.8%). Eighty-eight patients (52.3%) developed DNS, of which sixty-nine patients (78.4%) converted to LNS. The most common imaging manifestations were hypoxic ischemic damage in the basal ganglia (54.3%) and demyelination in white matter (45.7%). After multivariate analysis, initial GCS score and coma time were the independent risk factor for patients with DNS (p＜0.001). Interestingly, myocardial injury was more common in non DNS elderly patients than in DNS patients (p＜0.001); only coma time was an independent risk factor for patients with LNS (p＜0.001). There was no significant difference between HBO (p=0.196) and NBO (p=0.379) in the occurrence of DNS and LNS in elderly patients with CO poisoning. Conclusion: Only initial GCS score and coma time are the risk factors of DNS for elderly patients, and coma time alone is a high-risk factor for poor prognosis of CO poisoning in the elderly. Moreover, HBO is not superior to NBO in elderly patients with CO poisoning. Special attention should be given and follow-up should be performed to elderly patients, particularly those have longer coma time and CO exposure time, and lower initial GCS score in acute CO poisoning.

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Section: Discussionmentioning

confidence: 99%

Risk factors and Outcome Analysis of Delayed Neurological Sequelae in elderly patients with carbon monoxide poisoning

Xue

et al. 2023

Preprint

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“…Carbon monoxide (CO) is one of the main environmental causes of acute poisoning worldwide, and is associated with a high mortality rate and specific complications 1 – 5 . CO often originates from the incomplete combustion of hydrocarbon fuels in fires, stoves, charcoal briquette burners, boilers, chimneys, internal combustion engines, gas-fuelled water heaters, and so on 2 , 5 . Most patients with CO poisoning present to the emergency department (ED) with nonspecific symptoms and fully recover after oxygen therapy.…”

Section: Introductionmentioning

confidence: 99%

Real-world effectiveness of hyperbaric oxygen therapy for delayed neuropsychiatric sequelae after carbon monoxide poisoning

Liao

Shao

Yang

et al. 2021

Sci Rep

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To assess real-world effectiveness of hyperbaric oxygen therapy (HBOT) on delayed neuropsychiatric sequelae (DNS) after carbon monoxide (CO) poisoning we conducted a retrospective review of patients with CO poisoning admitted to Linkou Chang-Gung Memorial Hospital, Taiwan’s largest medical center, during 2009–2015. We included patients developing DNS after CO poisoning and compared improvements in neuropsychiatric function, with and without HBOT, after 12 months post-DNS to understand differences in recovery rates. DNS improvement-associated factors were also evaluated. We used receiver operating characteristic (ROC) curve analysis to assess the role of time elapsed between DNS diagnosis and HBOT initiation in predicting DNS improvement. A total of 62 patients developed DNS, of whom 11 recovered while the rest did not. Possible factors predicting DNS improvement included receiving HBOT post-DNS (72.7% vs 25.5%; P = 0.006), and treatment with more than three HBOT sessions during acute stage CO poisoning (81.8% vs 27.5%; P = 0.003). The relevant area under the ROC curve was 0.789 (95% CI 0.603–0.974), and the best cut-off point was 3 days post-DNS diagnosis, with 87.5% sensitivity and 61.5% specificity. Early HBOT in patients who developed DNS after CO poisoning significantly improved their DNS symptoms, with treatment effects sustained for 1 year after DNS diagnosis.

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Evaluating the Recommended Indications of HBOT

Gupta,

Somasundaram

2023

Hyperbaric Oxygen Therapy: Principles and Applications

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Current and research therapies for the prevention and treatment of delayed neurological syndrome associated with carbon monoxide poisoning: A narrative review

Cited by 7 publications

References 28 publications

Risk factors and Outcome Analysis of Delayed Neurological Sequelae in elderly patients with carbon monoxide poisoning

Risk factors and Outcome Analysis of Delayed Neurological Sequelae in elderly patients with carbon monoxide poisoning

Real-world effectiveness of hyperbaric oxygen therapy for delayed neuropsychiatric sequelae after carbon monoxide poisoning

Evaluating the Recommended Indications of HBOT

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